Vaccine Policy and an Alternative Vaccine Schedule
In my office I do not insist on any vaccine schedule. We administer the standard CDC schedule to those who don’t raise any issues (except, sometimes, MMR at 1 year old, which I will discuss in another place). Increasingly, however, parents are asking for an alternative vaccine schedule. These parents are generally well educated and well informed. They have concerns about the high number of shots at a young age, the side effects of these shots, and the harm in trusting an artificial immunity over a natural one. What they want most though is to learn, go slow, and not feel forced to do something that scares them.
My role is to maintain a respectful and professional relationship with my patients regardless of how they decide to vaccinate. This is the posture of the 2009 Red Book under PARENTAL REFUSAL OF IMMUNIZATION where it says, “continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (e.g., during an epidemic).” Later it says, “When significant differences in philosophy of care emerge, a substantial level of distrust develops, or poor quality of communication persists, the pediatrician can choose to encourage the family to find another physician…”
Parents have concerns about the high number of shots at a young age, the side effects of these shots, and the harm in trusting an artificial immunity over a natural one. What they want most though is to learn, go slow, and not feel forced to do something that scares them.
Unfortunately, Pediatricians are alienating parents more and more. Despite the above recommendation pediatricians have largely adopted a “zero tolerance” policy whereby a child can’t be a patient in the practice if they don’t vaccinate exactly as the ACIP (Advisory Comity on Immunization Practices) recommends. What the mother hears them saying to her is: “You are stupid. Even though you are his mother, your concerns don’t interest me and it’s not worth my time to even discuss this with you. If you don’t vaccinate exactly as I say, I don’t want you as my patient.” Naturally, this reinforces any skepticism that they had, and it destroys a trusting relationship. In my practice, I’d say 90% of “nonvaccinators” end up getting many vaccines. It’s not likely to happen on the first visit nor is it likely to be according to the CDC schedule, but in the end I vaccinate these patients a lot more than those with a zero tolerance policy.
Ultimately, I believe that vaccine policy will change in the direction of “less is better.” Vaccines do not have zero risk. The pharmaceutical companies are biased, and influence vaccine policy more than they should. Chickenpox is not smallpox. Hepatitis A is not polio. Papilloma virus is not HIV. Are we trying to eradicate the flu from the world? What if something happens whereby we can’t vaccinate 90% of the population forever? How then will a society that has become dependent upon a fragile artificial immunity deal with these germs? In forty years will the flu and chicken pox be like the plague? I think these questions and others are legitimate ones.